Historical development of mental health social work 1920 to 1939

Social work was established in the United Kingdom and the United States at the end of the nineteenth century. It developed out of the Charity Organisation Society which operated in both countries, focusing on financial support for the poor individual and family work. The second main strand in social work was represented by the Settlement Movement, which concentrated on improving the communal life of poor people by living with them, using community work methods to support and empower them.

Stuart(1) argues that American mental health social work in the pre-1920 period concentrated more on care in the community in its social, rather than its administrative or psychological, meaning than after 1920, when it shifted further to the psychological dimension.

In both countries social work was a product of liberal thinking which accepted capitalism as the main mode of production but wished to ameliorate its flaws and the suffering caused to poor children and adults in the process of the industrial revolution. Social work was created to carry out this function, as is modern social policy. Unlike social policy, however, it was envisaged that social work would be done via personal contact, as well as through providing the necessary resources and moral education to help people to regain control over their own lives.

However, the major impetus to developing mental health social work at the beginning of the twentieth century was related to the impact of the First World War on the approach of leading psychiatrists and psychologists to intervention strategies.

Western approaches to aggression, death, and mental breakdown were influenced by the carnage of First World War. It led Freud to develop his theory on death and aggression. Some British psychologists (e.g. William Rivers) and psychiatrists (e.g. Charles Myers) who worked with shell-shocked soldiers (the term used then to denote post-traumatic stress disorder) accepted that the soldiers' reactions were due to the experience of war. They concluded that to reduce suffering it was necessary to work with children and adults suffering from mental distress and illness outside the psychiatric hospital through personal and social support, including counselling and medication.(2) This approach lead to the establishment of the Tavistock Clinic in London, where the first psychiatric social worker was appointed in 1920.

Although the Tavistock Clinic was strongly influenced at that stage by Melanie Klein's ideas, the interventions provided by the clinic's social worker were much wider in scope. Social workers in the children section worked mainly with the parents and the teachers of the children referred to the clinic, focusing on the resolution of conflicts identified by the multidisciplinary team which also included psychiatrists and psychologists. Social workers provided a comprehensive psychosocial history of the child and the family, moved children from home when necessary, enabled parents and teachers to understand why the children behaved in the way they did, helped the parents and teachers to understand how they had unintentionally contributed to this state of affairs, and taught them how they could help to improve the mental health of the child.(3)

Social workers in the adult section provided psychosocial histories, worked on issues of going back to work, approached welfare services if needed, and supported relatives.

The first university course in which social workers trained began in 1929, at the London School of Economics, which lead to a diploma in psychiatric social work. The psychoanalyst Donald Winnicott and Claire Britton-Winnicott, who was a social worker at the Tavistock Clinic, both taught on the course. Apart from the focus on the psychodynamic approach students were taught social policy, sociology, law and research methods, and had a long, individually supervised, fieldwork placement. (3)

In contrast to the almoners (then the title of health social workers based in hospitals), qualified psychiatric social workers did not work within the psychiatric hospitals until the late 1950s. This was justified on the following grounds.

1. Hospitals were not seen as therapeutic environments in which social workers could use their skills respectfully and effectively.

2. Working in the community fitted much better with the ideal of social work to provide psychosocial support and work on both the psychological and social aspects of clients' lives and to do so where they lived.

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